Anesethetics (Local)

Question 1

Local anaesthetic drugs act by causing a _____________ to ____________.

Answer 1

reversible block

conduction along nerve fibres

Question 2

What are the different types of local anesthetic?(7)

Answer 2

1. Topical (surface)
2. Infiltration
3. Peripheral nerve block
4. Intravenous regional anesthesia (Bier’s block)
5. Plexus block
6. Epidural (extradural)
7. Spinal block (intrathecal or subarachnoid

Question 3

Local anaesthetics may also be used for ____________ pain relief, thereby reducing the need for ____________

Answer 3

postoperative

analgesics (such as opioids)

Question 4

_________________ has a longer duration of action than other local anaesthetics

Answer 4

Bupivacaine hydrochloride

Question 5

_______________ (local anesthetic) has a slow onset of action, taking up to 30 minutes for full effect

Answer 5

Bupivacaine hydrochloride

Question 6

__________________ (local anesthetic) is often used in lumbar epidural blockade and is particularly suitable for continuous epidural analgesia in labour, or for postoperative pain relief

Answer 6

Bupivacaine

Question 7

Bupivacaine is often used in _____________ blockade and is particularly suitable for continuous _______________ in _________, or for ___________ pain relief

Answer 7

lumbar epidural

epidural analgesia

labour

postoperative

Question 8

_______________ is the principal drug used for spinal anaesthesia

Answer 8

Bupivacaine

Question 9

Levobupivacaine is an ___________ of bupivacaine

Answer 9

isomer

Question 10

Levobupivacaine, an isomer of bupivacaine, has _______________ and _____________ properties similar to bupivacaine hydrochloride, but is thought to have fewer ____________ effects.

Answer 10

anaesthetic

analgesic

adverse

Question 11

Lidocaine hydrochloride is effectively absorbed from ______________ and is a useful __________ anaesthetic in concentrations up to 10%.

Answer 11

mucous membranes

surface

Question 12

Except for surface anaesthesia and dental anaesthesia, lidocaine solutions should not usually exceed ____% in strength.

Answer 12

1

Question 13

The duration of the block generated by lidocaine (with adrenaline/epinephrine) is about ________ minutes.

Answer 13

90

Question 14

______________ is a local anaesthetic of low toxicity which is similar to lidocaine hydrochloride.

Answer 14

Prilocaine hydrochloride

Question 15

_______________ is an amide-type local anaesthetic agent similar to bupivacaine hydrochloride

Answer 15

Ropivacaine hydrochloride

Question 16

Ropivacaine hydrochloride is less ___________ than bupivacaine hydrochloride, but also less ___________.

Answer 16

cardiotoxic

potent

Question 17

___________ is rapidly absorbed from mucous membranes and should never be applied to inflamed, traumatized, or highly vascular surfaces

Answer 17

Tetracaine

Question 18

Tetracaine should never be used to provide anesthesia for ____________ or _____________ because lidocaine is a safer alternative

Answer 18

Bronchoscopy

Cystoscopy

Question 19

The dose of local anaesthetic depends on the __________ and the ____________ used.

Answer 19

injection site

procedure

Question 20

In determining the safe dosage of local anesthetic, it is important to take account of the rate of __________ and _________, and of the __________. The patient’s ___________, ___________, __________, and ____________, and the ___________ of the administration site and the duration of administration, must also be considered.

Answer 20

absorption

excretion

potency

age

weight

physique

clinical condition

vascularity

Question 21

Uptake of local anaesthetics into the systemic circulation determines their ____________ and produces ___________.

Answer 21

duration of action

toxicity

Question 22

Uptake of local anaesthetics into the _____________ determines their duration of action and produces toxicity.

Answer 22

systemic circulation

Question 23

NHS Improvement has advised (September 2016) that, prior to administration, all injectable medicines must be __________________ and should never be ______________.

Answer 23

drawn directly from their original ampoule or container into a syringe

decanted into gallipots or open containers

• This is to avoid the risk of medicines being confused with other substances, e.g. skin disinfectants, and to reduce the risk of contamination.

Question 24

Great care must be taken to avoid accidental ______________; local anaesthetic injections should be given slowly in order to detect inadvertent ______________ administration.

Answer 24

intravascular injection

intravascular

Question 25

When prolonged analgesia is required, a ___________ local anaesthetic is preferred to minimise the likelihood of _____________

Answer 25

long-acting cumulative systemic toxicity

Question 26

Local anaesthesia around the oral cavity may impair ___________ and therefore increases the risk of ___________.

Answer 26

swallowing aspiration

Question 27

____________ (local anesthesia) anaesthesia is commonly used during surgery, often combined with general anaesthesia, because of its protective effect against the stress response of surgery. It is often used when good postoperative pain relief is essential

Answer 27

Epidural

Question 28

Local anaesthetics cause _____________ of blood vessels. The addition of a _____________ such as ______________ to the local anaesthetic preparation diminishes local blood flow, slowing the rate of absorption and thereby prolonging the anaesthetic effect.

Answer 28

dilatation vasoconstrictor adrenaline/epinephrine

Question 29

Local anaesthetics cause dilatation of blood vessels. The addition of a vasoconstrictor such as adrenaline/epinephrine to the local anaesthetic preparation diminishes _____________, slowing the rate of _____________ and thereby prolonging the anaesthetic effect.

Answer 29

local blood flow absorption

Question 30

It is not advisable to give adrenaline/epinephrine with a local anaesthetic injection in __________ or ___________ because of the risk of ischaemic necrosis.

Answer 30

digits appendages

Question 31

Adrenaline/epinephrine must be used in a __________ (high/low) concentration when administered with a local anaesthetic

Answer 31

Low

Question 32

In patients with severe ____________ or _____________, the use of adrenaline/epinephrine with a local anaesthetic may be hazardous. For these patients an anaesthetic without adrenaline/epinephrine should be used.

Answer 32

hypertension unstable cardiac rhythm

Question 33

_______________ (local anesthetic agent) is widely used in dental procedures

Answer 33

Lidocaine hydrochloride; most often used in combination with adrenaline

Question 34

The amide-type local anaesthetics _________ and ___________ are also used in dentistry

Answer 34

articaine mepivacaine

Question 35

In patients with severe hypertension or unstable cardiac rhythm, mepivacaine hydrochloride without _________________ may be used.

Answer 35

adrenaline/epinephrine

Question 36

Felypressin can cause __________________ when used at high doses

Answer 36

coronary vasoconstriction; limit dose in patients with coronary artery disease

Question 37

What is severe local anesthetic-induced CV toxicity?

Answer 37

After injection of a bolus of local anesthetic, toxicity may develop at any time in the following hour This may involve cardiac toxicity, arrhythmias, and arrest, of which hypotension and braycardia are often the first signs

Question 38

In the event of local anaesthetic-induced cardiac arrest, ______________ should be initiated immediately. __________ must not be used as anti-arrhythmic therapy.

Answer 38

standard cardiopulmonary resuscitation Lidocaine

Question 39

In cases of local anesthetic-induced cardiac arrest that do not respond rapidly to standard procedures, _______________ should be administered

Answer 39

Lipid emulsion (20%) *standard CPR must be maintained throughout lipid emulsion treatment; propofol is not a suitable alternative to lipid emulsion

Question 40

How is dose calculated for bupivacaine admisinstration?

Answer 40

Should be calculated based on ideal body-weight

Question 41

What are the contraindications to bupivacaine? (4)

Answer 41

1. Injection into infected tissue 2. Injection into inflamed tissues 3. Intravenous regional anesthesia 4. Preparations containing preservatives should not be used for caudal, epidural, or spinal block

Question 42

What are the common or very common side effects of bupivacaine? (6)

Answer 42

1. Arrhythmias 2. Dizziness 3. Hypertension or hypotension 4. N/V 5. Paresthesias 6. Urinary retention

Question 43

Toxic effects after administration of local anaesthetics are a result of ____________; severe toxicity usually results from ____________.

Answer 43

excessively high plasma concentrations inadvertent intravascular injection

Question 44

The systemic toxicity of local anaesthetics mainly involves the ____________ and ___________ systems.

Answer 44

central nervous cardiovascular

Question 45

The onset of toxicity from local anesthetics can be _______________. Monitor as per local protocol for at least ________ minutes after administration.

Answer 45

unpredictable and delayed 30

Question 46

Hypersensitivity reactions occur mainly with the ester-type local anaesthetics, such as __________; reactions are less frequent with the amide types, such as articaine, bupivacaine, levobupivacaine, lidocaine, mepivacaine, prilocaine, and ropivacaine.

Answer 46

tetracaine

Question 47

Large doses of bupivacaine during delivery can cause ____________, __________, and ___________ after epidural block.

Answer 47

neonatal respiratory depression hypotonia bradycardia

Question 48

Is bupivacaine safe to administer to patients with hepatic and/or renal impairment?

Answer 48

Use caution in advanced disease

Question 49

What are the contraindications to IV lidocaine? (3)

Answer 49

1. All grades of AV block 2. Severe myocardial depression 3. SA disorders

Question 50

Which drug interactions should be avoided when prescribing lidocaine?

Answer 50

Avoid coprescription with beta blockers due to increased risk of CV adverse effects